Healthcare Provider Details

I. General information

NPI: 1467088948
Provider Name (Legal Business Name): KELSEY GALICIA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 BELLEVUE AVE
SAINT LOUIS MO
63117-1996
US

IV. Provider business mailing address

1027 BELLEVUE AVE
SAINT LOUIS MO
63117-1996
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-5375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number2020006960
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: